Transcript Document

15th General Meeting of
Stakeholders
28 August 2008
Progress in implementation of the GF-supported R1 & 6 Grants by the
ICF “International HIV/AIDS Alliance in Ukraine :
Andriy Klepikov
Executive Director, International HIV/AIDS Alliance in Ukraine
Major achievements by 1 July 2008:
 Start up of the methadone-based substitution therapy
273 patients (first patients from the end of May 2008)
Total patients on ST: 1100 persons
 AIDS mortality rate continues decreasing in 2008
New AIDS cases: 4 573 in 2007 vs. 4 723 in 2006
2295 over ½ 2008 (2372 over ½ 2007)
 5 684 patients taking ART(63% of total number of 9005 GF+state
budget)
 9112 pregnant women received PMTCT (planned: 8575)
 4 major indicators of the R6 Programme: IDU, FSW, MSM, inmates
prevention coverage - exceeded
 Start up of the STI screening and treatment among IDU, FSW, MSM
(16 294 syphilis tests, joint action plan with the MoH)
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1 Year R6: key achievements
 94 grantees received funding
202 grant agreements with total budget of UAH 12 252 971
+58 organizations got condoms for prevention programmes (total
number of sub-grantees: 152 organisations)
 «Peer Driven Interventions»: intervention piloted by 5 NGOs till
October 2007. 15 implementers in regions starting from May 2008.
 Community centers for IDU and FSW: 27 in 22 cities of Ukraine
 Pharmacy interventions: 30 pharmacies in 8 cities, 2000 clients, 15
000 visits
 VCT with rapid tests: 42 274 rapid tests in prevention projects
 14 mobile clinics (VCT+HIV rapid tests, syphilis, chlamydia and
gonorrhea): start up from 1 October 2008
 HIV prevention among injecting stimulants users: start up from 1
October 2008
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Open call for proposals: 2008-09 Programme year,
interim results
 12 prevention directions were announced
 The CFP budget is $ 8,3 mln
 93 NGOs out of 128 applied pre-approved
Direction
Budget, $
# of NGOs with
prior confirmation
1. HIV prevention among the IDUs, community centers for the IDUs
2. HIV prevention among the IDUs-stimulants
$4 127 709,00
67
3. HIV prevention among the FSW, community centers for the FSW
$1 022 956,00
36
4. HIV prevention among the MSM, community centers for the MSM
$467 919,00
14
5. HIV prevention in penitentiary establishments
$309 600,00
19
$10 000,00
0
8. HIV/AIDS Information Center
$240 120,00
9
9. Development of regular information materials for the HIV vulnerable populations on the
national level
$452 400,00
9
10. Mobilization and capacity building of the HIV vulnerable communities
$195 000,00
2
11. Medical and social and psychological support for the substitution maintenance therapy
programmes
$842 654,00
24
12. HIV prevention among the IDUs according to the “Peer Driven Intervention” model
$700 000,00
17
7. National advocacy of interests of HIV vulnerable populations
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STI area: cooperation progress
 The MOH Working Group established and action plan, to give access
to the STI diagnostics and treatment for vulnerable groups, approved
 4 regional trainings for the STI doctors (50 people) and All-Ukrainian
joint meeting of the regional AIDS Centers chief doctors and regional
STI doctors
 66 agreements on diagnostics and treatment concluded between
NGOs and STI clinics
 Agreement with the Academic Institute of Dermato-Venerology signed
to develop method guidelines on STI treatment among vulnerable
populations
 55 658 syphilis rapid tests procured and delivered to all regions
(16 294 syphilis screening tests conducted )
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Achievement of Rounds 1 and 6 main programme indicators
0%
20%
40%
60%
80%
100%
5 684
People taking ARV therapy*
162 583
IDU covered by HIV/AIDS prevention programmes
Commercial sex workers (CSW) covered by
HIV/AIDS prevention programmes
Men having sex with men (MSM) covered by
HIV/AIDS prevention programmes**
25 601
13 417
50 761
Inmates covered by prevention programmes
VCTs conducted (including provision of test results)
for HIV with rapid tests among vulnerable groups**
STI screening tests provided to vulnerable groups**
STI counselling and treatment courses received by
people from vulnerable groups**
Visits by people from vulnerable groups to mobile
clinics**
Condoms distributed to vulnerable groups
* - Round 1 only
** - Round 6 only
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120%
42 274
16 294
0
0
8 955 230
140%
Key targets on coverage: end of Year 2 of R6 Programme
implementation
Indicator
Achieved as of 01.07.08
Target at the end of the 2nd Year
(01.07.2009)
Number and percentage of IDU covered by the
HIV/AIDS prevention programmes
162,583
170,000
(52% of estimated number)
Number and percentage of FSW covered by
the HIV/AIDS prevention programmes
25,601
23,000
(21% of estimated number)
Number and percentage of MSM covered by
the HIV/AIDS prevention programmes
13,417
13,800
(7,8% of estimated number)
Number and percentage of inmates covered by
the HIV/AIDS prevention programmes
50,761
43,500
(27% of estimated number)
VCT and HIV rapid testing among risk groups
42,274
158,600
STI screening tests among risk groups
16,294
153,830
STI counseling and treatment courses among
vulnerable groups
0
38,206
Risk groups visits to mobile clinics
0
30,000
8, 955,230
23,980,000
Condoms distributed among the risk groups
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Alliance Ukraine’s Expenses vs Budget of the Rd 1 Year5:
October 2007 – June 2008 (USD)
6 048 115 (78%*)
1 699 931 (76%*)
476 054 (84%*)
1 693 720 (94%*)
Treatment, Care & Support
Focused Prevention
Information, Education & Advocacy
Surveillance & Evaluation
Management / PR Implementation Unit
• *Budget performance percentages
• Total: $13,399,566 or 82%
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3 481 736 (89%*)
Expenses of the 1st Year Rd 6 vs budget for August 2007 –
June 2008 (USD)
210 516 (74%*)
34 679 (112%*)
73 030 (15%*)
3 202 027 (72%*)
Ensuring adequate access to comprehensive services on prevention, treatment,
care and support for vulnerable communities
Creating favourable environment for sustainable and effective response to HIV and
AIDS in Ukraine
Monitoring and evaluation of grant imple-mentation and strengthening of national
monitoring and evaluation system
Programme management and implem-entation by Principal Recipient
•*Budget performance percentages
• Total: $3,520,253 USD or 68%
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Summary budget by component of the Year 2 Rd 6 Grant: July
2008 – June 2009
1 139 899,05
589 407,78
31 827,00
8 694 116,23
v
Total 10 455 250 USD
To ensure sufficient access to integrated prevention, treatment, care and support
for marginalized populations
To create a supportive environment for a sustainable and sufficient response to
HIV/AIDS in Ukraine (in the part administered by Alliance, Ukraine as a PR)
To monitor and evaluate grant implementation and strengthen the national M&E
system
Management / PR Implementation Unit
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AU Organisation development plans
 Strategy for transition from the Country Office of Alliance to an
independent Linking Organisation with a membership at the Global
Alliance Partnership (statute reviewed and new governance bodies to
be set up by the end of 2009 1st quarter)
 Strengthen internal compliance and programme oversight. New
position of Senior Advisor on compliance and internal procedures (by
the PR and sub-grantees)
 Develop an action plan to respond to evaluation
recommendations – after finalizing External Evaluation Report of the
National 2004-2008 HIV/AIDS Response, incl. GF grants
implementation.
 Improve quality of work with sub-grantees (develop and implement
a technical assistance provision plan, introduce and support
development of new EFR reporting; better oversight and quality
assurance of services provided by the Alliance-Ukraine sub-grantees
within the GF and other donors’ programmes).
www.aidsalliance.org.ua
Major challenges: SMT
 Slow enrollment of patients for the methadone-based SMT (the
MoH Order № 295 of 04.06.2007 not implemented in the AR of
Crimea, Zaporizhzhya, Mykolayiv and Kherson oblasts)
 Lack of state health system structure to take responsibility for
the SMT programmes. The health care settings lack staff to work
with SMT patients; there is no state centralized monitoring system for
the SMT projects including patients’ records and drugs for SMT. No
unified system for SMT patients registration.
 2007 state budget for buprenorphine-based SMT was not spent,
while there is no money for SMT in 2008 state budget at all
 Current legal regulations on narcotic drugs do not allow a
comprehensive SMT implementation; they require urgent review.
The SMT patients are “chained” to points of drugs provision; it is not
possible to administer liquid methadone.
www.aidsalliance.org.ua
STI: challenges and responses
 Late treatment start up: the MoH issued the Order № 325 „On
distribution of STI treatment drugs among the risk groups procured
with support of the GF grant” only on 18 June 2008
 The current official STI management system of diagnostics fails to
account for peculiarities of diagnostics and treatment of HIV
vulnerable groups as well as for complexity of epidemiology; System
requires urgent review.
Plans:
 Establish a national coordination centre of STI diagnostics and
treatment among vulnerable groups
 Develop Instruction on conducting STI screening tests among
vulnerable groups
 Procure and deliver the gonorrhea and chlamydia rapid tests for
mobile clinics
 Develop postgraduate training module for doctors on the STI among
the risk groups
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Prevention: challenges and responses
 Risk of delays in procurement and supply of syringes and other
medical goods by the MoH with the World Bank HIV loan to the
projects supported by the GF;
 Lack of national mechanism of coordination, analysis and adaptation
of prevention programmes among the vulnerable groups as well as
care and support.
Plans:
 Establish an external expert working group on HIV/AIDS prevention
among the vulnerable groups (in coordination with current WGs on
M&E, treatment and ST, STI, and prevention among MSM).
 Initiate re-establishment of subcommittees of the National HIV/AIDS
and TB Coordination Council
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ART and PMTCT: problem areas
 ART is offered to appr. 35% of those who need it;
 Continuation of treatment and PMTCT after the GF funding is over
(from 1 October 2008), incl.:
• ARV drugs for 6000 patients as well as HIV-positive pregnant
women and newborns
• Laboratory follow up for treatment and PMTCT
• Multi-disciplinary approach and psycho-social support for the ART
patients
• Training of medical staff in ART issues and other aspects of
medical care of HIV-infected and AIDS patients, incl. palliative
care
• Introducing the ART clinical monitoring system
• Provision of milk formulas for the PMTCT from local budgets
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Education component handover to the GoU
Achievements: in close cooperation with the Ministry of Education regular
Health Promotion curricula introduced; course books developed and experts
trained.
Problem
 The Ministry of Education has limited state support for continuation of
prevention programmes from September 2008
 Low priority for HIV prevention via education system at the operational level
and in budget provision on the level of CabMin
 Low institutional and financial capacity of the Ministry of Education
Next steps
 Special analytical report with practical recommendations on capacity building
and budgeting of further prevention activities via education system
 National round table on prevention via education system to develop practical
steps on the component handover
 Advocacy of the state responsibility for continuation and scaling up the
prevention programmes via education system with the mass media
involvement
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Humanitarian aid status
Problem
 The Government refuses to grant a humanitarian aid status to the medical
drugs and goods procured with the GF grant (Round 6)
 Estimated amount of customs and tax duties - 50 mln. UAH by 2012.
Progress: 0!
 The CabMin Commission on Humanitarian Aid refused repeatedly the Alliance
Ukraine in granting a humanitarian aid donor status with reagrd to medical
goods procured with GF grant
 Alliance Ukraine received no answer to the letters addressed to the Vice Prime
Minister, the Minister of Health and the President during last months
Possible steps:
 Start a new advocacy campaign to attract media and public attention
 Arrange meetings with the Prime Minister of Ukraine and Verkhovna Rada of
Ukraine.
 Initiate amendments to the relevant legislation of Ukraine
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